What is the clinical evidence from this study?

Study design: Cohort. Population: acute stroke (n=250). Intervention: Dual antiplatelet therapy vs. Single antiplatelet therapy. Primary outcome: recurrence of ischemic stroke within 90 days (p=0.312).

July 10, 2025Cureus0 citationsOpen Access

Comparative Effectiveness of Dual Antiplatelet Therapy Versus Single Antiplatelet Therapy in Patients With Acute Stroke

AAAwais AslamRussells Hall Hospital MSMuhammad Hamza SaeedToho University SBSyeda Wajiha BatoolUniversity of Azad Jammu and Kashmir

Key Result

Dual antiplatelet therapy did not significantly reduce the 90-day risk of recurrent ischemic stroke compared to single antiplatelet therapy in patients presenting with acute stroke.

Study Design

Type

Cohort (n=250)

Multicenter

Structured PICO

Does dual antiplatelet therapy reduce the recurrence of ischemic stroke within 90 days compared to single antiplatelet therapy in adult patients with acute stroke (NIHSS ≤3)?

Population

250 adult patients aged 40-89 years with acute stroke (NIHSS ≤3) followed for 90 days.

Exposure

Dual antiplatelet therapy (DAPT) assigned based on clinical judgment of the treating physician

Comparator

Single antiplatelet therapy (SAPT) assigned based on clinical judgment of the treating physician

Outcome

Recurrence of ischemic stroke within 90 days, confirmed by clinical assessment and neuroimaging (CT or MRI)hard clinical

In this retrospective cohort of patients with acute mild stroke, dual antiplatelet therapy was not significantly superior to single antiplatelet therapy for preventing 90-day stroke recurrence.

Main Result

p-value: p=0.312

Limitations

Retrospective observational design lacking randomization introduces potential selection bias and confounding
Single-center setting and demographically homogenous population limit generalizability
Data extracted from medical records without standardized follow-up increases risk of misclassification
Therapy duration, adherence, and time-to-event data were unavailable
Bleeding events were not stratified into major or minor
Important biomarkers and genetic factors influencing treatment response were not evaluated

Abstract

This retrospective observational cohort study aimed to evaluate the comparative effectiveness of dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) in patients presenting with acute stroke at a tertiary care center in Muzaffarabad. A total of 250 patients aged 40-89 years (mean age=63.89; n=136; 54.4% female) were included, categorized into DAPT (n=129) or SAPT (n=121) groups. Baseline characteristics were evenly distributed, including hypertension (n=127; 50.8%), diabetes (n=120; 48%), and hyperlipidemia (n=124; 49.6%). The main outcome was recurrence of ischemic stroke within 90 days, confirmed by clinical assessment and neuroimaging (computed tomography (CT) or magnetic resonance imaging (MRI)). Secondary outcomes included any bleeding event (defined as documented clinical bleeding with no methodological categorization into major bleeding, minor bleeding, bleeding at a particular site, or bleeding by time), and mortality from any cause. The following medical comorbidities were recorded in patients: stroke in 133 (53.2%), bleeding in 131 (52.4%), and mortality in 127 (50.8%). Independent samples t-tests and chi-squared tests showed no significant difference in recurrence, bleeding, or mortality between treatment arms (p>0.05). Logistic regression indicated that former smoking (OR=0.331; p=0.003), transient ischemic attack (TIA) history (OR=1.884; p=0.031), and aspirin use (OR=0.468; p=0.012) were significant predictors of stroke recurrence. DAPT was not an independent predictor (p=0.583). These findings suggest that while DAPT may offer theoretical benefits, it was not significantly superior to SAPT in this cohort.

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